intraventricular lesions by endoscopy

8/8/2019 Intraventricular lesions by endoscopy

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Introduction..y Intraventricular tumors and cysts are ideallesions for the application of neuroendoscopy.y Good visualization is possible dueto their location inside the cerebrospinal fluid(CSF)-filled ventricular system;y The often-associated

obstruction of the CSF pathway and ventricularenlargement offer the possibility of

working in large spaces


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IntroductionHistory..y In 1963, Guiot et al. reported the use of ventriculoscopy in a

patient with a colloid cyst.y In 1973, Fukushima et al. provided the first modern

description of an endoscopic biopsy with the introduction of the ventriculo-fiberscope.

y The evolution of endoscopic techniques and improvement inadequacy of diagnosis have allowed us to dramatically changethe prognosis and therapeutic regimen in pineal regiontumors;


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Patient Selectiony Endoscopic Biopsy of Intraventricular and

Paraventricular Tumors.y Endoscopy permits the simultaneous treatment of

associated hydrocephalus by means of a third ventriculostomy E3V or septostomy.y In patients with small ventricles, endoscopy can be

associated with neuronavigation or, eventually, withstereota y.

y Paraventricular parenchymal tumors (i.e.,thalamomesencephalic or basal ganglia), anendoscopic biopsy can be performed if there is anintraventricular e tension of the lesion.


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Endoscopic Techniquey Anterior two-thirds of the lateral and third ventricle can

be approached through a frontal pre-coronal burr hole.y For the pineal region, a steerable endoscope prefered

through a coronal burr hole to assure safer maneuvers for biopsy and ETV.y In case of trigonal tumor transoccipital approach used.y When an ETV is necessary, biopsy should be performed

first to prevent blood from reaching the interpeduncularcistern.

y The burr hole must be large enough to accommodate a wand-like motion of the scope.


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Endoscopic Techniquey Usually an 8.9-mm cannula used for tumor

resection. This permits the use of a scope with a 4-mm viewing port and an instrument port largeenough to accommodate the insertion of 2-mmdiameter instruments.

y If one needed to work in the third ventricle, then asmaller-diameter cannula with smaller instruments

would be used to avoid injury to the forni , unlessthe foramen of Monro is unusually large.


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Endoscopic Techniquey A solid tumor should not e ceed 2 cm in diametery Cystic lesions may be treated even if they are large.y The endoscopic removal may become time-

consuming and ineffective if the tumor is too largeand too firm.

y General principle is interruption of the blood supply to the tumor and subsequent tumor debulking.

y In general, a piecemeal resection is performed.


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Lesions.eo l sticy olloi c stsy stic r nio r n io rojectin in l t enty

y e t l lioy enin n Intr entric l r c sts

on- eo l sticyy e t te roce l s


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Colloi c stsColloi c sts are, in fact, the intra-ventricular lesi ons

that have been m ost often manage b using

en oscopic treatments.The a vantage of en oscopic surger c ompare with

micr osurger sh oul be l o wer m orbi it , sh orteroperative time, an sh orter h ospital sta .

This has been ocumente onl in cases of colloic sts, whereas this o bservati on is anec otal f or othertum ors as a result of t h e l o w number of cases


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Colloid cyst


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Colloid cyst


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Cystic Cranio-pharyngioma Projecting inlateral ventricle


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Septal Glioma


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Pineal- Germ cell tumor


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Giant Pineal cyst


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In trave n tricular No n tumoral Lesio n s:Neurocysticercosis


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NCC..Lat vent


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VideoNCC


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Post-op MRI


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NCC ..4 th vent


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Name/Age/sex Diag n osis Procedure Histology

M oh si /10/ r

e tr Cr iopha r ioma Endo scop ic

spiration /decomp ressi on

Cran iopha r ngioma

San skriti/1 /f Rec. c sticCran iopha r ngioma

Endo scop ic

spiration /decomp ressi on (twice)

Cran iopha r ngioma

R oh it/5/ m Rt L at. I ntr a ventricul ar gian tc st

M ulti ple fe nestr ation /septost omy

Cho roid ple us c y st

Ruc hi/ /f I ntr a3 rd ventricul ar m ulti plegian t c y sts

Endo scop ic

spiration /decomp ressi on

Biop s y -Post r ad iation simp le c y st

R ah ul/ 3/ m Lt Lat

entricul ar

CC Endo scop ic re mo v al

CC

R a vind er/1 / m Co lloid c y st Endo scop ic decomp ressi on Co lloid c y st

tar si ngh 55/ m Septal lioma / hyd rocepha lus ETV &

iops y Incon clusive

Patients Profile & Results

A n a n d swaroop/50/m hydrocephalus E3V & 4 th ve n t cyst 2 NCC from 4 th ve n t

Ram singh/45/m Colloid cyst Aspiration removal Colloid cyst

Deepak/15/m Post 3 rd vent tumor Hydro Biopsy/ E3V GCT


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Tak e hom eMS

y Cystic Lesi ons are best tre ated even if y ou are a Beginner.

y

Cystic lesi ons tre ated ha ve good rec o very even w henpatient is in L o w GCSy Tumo r bi opsy along wit h CS F diversi on d oing E3V

give best results.y Wit h impr o vement of e perience, it is p ossible t o

re mo ve selected tu mo rs c om pletely wit h a purely end oscopic tec hnique


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intraventricular lesions by endoscopy

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